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Cochrane Database of Systematic Reviews

Screening for breast cancer with mammography

Information

DOI:
https://doi.org/10.1002/14651858.CD001877.pub5Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 04 June 2013see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Breast Cancer Group

Copyright:
  1. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Peter C Gøtzsche

    Correspondence to: The Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark

    [email protected]

  • Karsten Juhl Jørgensen

    The Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark

Contributions of authors

PCG wrote the draft protocol and did the searches. Two authors extracted the main data independently and contributed to the review. PCG is guarantor.

Sources of support

Internal sources

  • Rigshospitalet, Denmark.

External sources

  • Danish Institute for Health Technology Assessment, Denmark.

Declarations of interest

None. We had no a priori opinion on the effect of screening for breast cancer when we were asked by the Danish National Board of Health in 1999 to review the randomised trials.

Acknowledgements

We thank Freda Alexander, Ingvar Andersson, Cornelia Baines, Niels Bjurstam, Gunnar Fagerberg, Jan Frisell, Anthony B Miller and Sam Shapiro for comments on their trials, Friederike M Perl for pointing out an inconsistency in one of the trials, Mike Clarke for advice, Ole Olsen who was an author on the 2001 version of this review and wrote the draft section on methodological quality of the trials for that version, Kay Dickersin for comments on the 2006 update of the review, and Margrethe Nielsen who was an author on the 2006 and 2009 updates.

Version history

Published

Title

Stage

Authors

Version

2013 Jun 04

Screening for breast cancer with mammography

Review

Peter C Gøtzsche, Karsten Juhl Jørgensen

https://doi.org/10.1002/14651858.CD001877.pub5

2011 Jan 19

Screening for breast cancer with mammography

Review

Peter C Gøtzsche, Margrethe Nielsen

https://doi.org/10.1002/14651858.CD001877.pub4

2009 Oct 07

Screening for breast cancer with mammography

Review

Peter C Gøtzsche, Margrethe Nielsen

https://doi.org/10.1002/14651858.CD001877.pub3

2009 Jul 08

Screening for breast cancer with mammography

Review

Peter C Gøtzsche, Margrethe Nielsen

https://doi.org/10.1002/14651858.CD001877.pub2

2001 Oct 23

Screening for breast cancer with mammography

Review

Ole Olsen, Peter C Gøtzsche

https://doi.org/10.1002/14651858.CD001877

Differences between protocol and review

A new outcome was added when we discovered that breast cancer mortality is an unreliable outcome. This was mortality from any cancer.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Comparison 1 Screening with mammography versus no screening, Outcome 1 Deaths ascribed to breast cancer, 7 years follow up.
Figures and Tables -
Analysis 1.1

Comparison 1 Screening with mammography versus no screening, Outcome 1 Deaths ascribed to breast cancer, 7 years follow up.

Comparison 1 Screening with mammography versus no screening, Outcome 2 Deaths ascribed to breast cancer, 13 years follow up.
Figures and Tables -
Analysis 1.2

Comparison 1 Screening with mammography versus no screening, Outcome 2 Deaths ascribed to breast cancer, 13 years follow up.

Comparison 1 Screening with mammography versus no screening, Outcome 3 Deaths ascribed to breast cancer, 7 years follow up, women below 50 years of age (Malmö 55).
Figures and Tables -
Analysis 1.3

Comparison 1 Screening with mammography versus no screening, Outcome 3 Deaths ascribed to breast cancer, 7 years follow up, women below 50 years of age (Malmö 55).

Comparison 1 Screening with mammography versus no screening, Outcome 4 Deaths ascribed to breast cancer, 7 years follow up, women at least 50 years of age (Malmö 55).
Figures and Tables -
Analysis 1.4

Comparison 1 Screening with mammography versus no screening, Outcome 4 Deaths ascribed to breast cancer, 7 years follow up, women at least 50 years of age (Malmö 55).

Comparison 1 Screening with mammography versus no screening, Outcome 5 Deaths ascribed to breast cancer, 13 years follow up, women below 50 years of age.
Figures and Tables -
Analysis 1.5

Comparison 1 Screening with mammography versus no screening, Outcome 5 Deaths ascribed to breast cancer, 13 years follow up, women below 50 years of age.

Comparison 1 Screening with mammography versus no screening, Outcome 6 Deaths ascribed to breast cancer, 13 years follow up, women at least 50 years of age.
Figures and Tables -
Analysis 1.6

Comparison 1 Screening with mammography versus no screening, Outcome 6 Deaths ascribed to breast cancer, 13 years follow up, women at least 50 years of age.

Comparison 1 Screening with mammography versus no screening, Outcome 7 Deaths ascribed to any cancer, all women.
Figures and Tables -
Analysis 1.7

Comparison 1 Screening with mammography versus no screening, Outcome 7 Deaths ascribed to any cancer, all women.

Comparison 1 Screening with mammography versus no screening, Outcome 8 Overall mortality, 7 years follow up.
Figures and Tables -
Analysis 1.8

Comparison 1 Screening with mammography versus no screening, Outcome 8 Overall mortality, 7 years follow up.

Comparison 1 Screening with mammography versus no screening, Outcome 9 Overall mortality, 13 years follow up.
Figures and Tables -
Analysis 1.9

Comparison 1 Screening with mammography versus no screening, Outcome 9 Overall mortality, 13 years follow up.

Comparison 1 Screening with mammography versus no screening, Outcome 10 Overall mortality, 7 years follow up, women below 50 years of age.
Figures and Tables -
Analysis 1.10

Comparison 1 Screening with mammography versus no screening, Outcome 10 Overall mortality, 7 years follow up, women below 50 years of age.

Comparison 1 Screening with mammography versus no screening, Outcome 11 Overall mortality, 7 years follow up, women at least 50 years of age.
Figures and Tables -
Analysis 1.11

Comparison 1 Screening with mammography versus no screening, Outcome 11 Overall mortality, 7 years follow up, women at least 50 years of age.

Comparison 1 Screening with mammography versus no screening, Outcome 12 Overall mortality, 13 years follow up, women below 50 years of age.
Figures and Tables -
Analysis 1.12

Comparison 1 Screening with mammography versus no screening, Outcome 12 Overall mortality, 13 years follow up, women below 50 years of age.

Comparison 1 Screening with mammography versus no screening, Outcome 13 Overall mortality, 13 years follow up, women at least 50 years of age.
Figures and Tables -
Analysis 1.13

Comparison 1 Screening with mammography versus no screening, Outcome 13 Overall mortality, 13 years follow up, women at least 50 years of age.

Comparison 1 Screening with mammography versus no screening, Outcome 14 Number of mastectomies and lumpectomies.
Figures and Tables -
Analysis 1.14

Comparison 1 Screening with mammography versus no screening, Outcome 14 Number of mastectomies and lumpectomies.

Comparison 1 Screening with mammography versus no screening, Outcome 15 Number of mastectomies.
Figures and Tables -
Analysis 1.15

Comparison 1 Screening with mammography versus no screening, Outcome 15 Number of mastectomies.

Comparison 1 Screening with mammography versus no screening, Outcome 16 Number treated with radiotherapy.
Figures and Tables -
Analysis 1.16

Comparison 1 Screening with mammography versus no screening, Outcome 16 Number treated with radiotherapy.

Comparison 1 Screening with mammography versus no screening, Outcome 17 Number treated with chemotherapy.
Figures and Tables -
Analysis 1.17

Comparison 1 Screening with mammography versus no screening, Outcome 17 Number treated with chemotherapy.

Comparison 1 Screening with mammography versus no screening, Outcome 18 Number treated with hormone therapy.
Figures and Tables -
Analysis 1.18

Comparison 1 Screening with mammography versus no screening, Outcome 18 Number treated with hormone therapy.

Comparison 1 Screening with mammography versus no screening, Outcome 19 Mortality among breast cancer patients in the Two‐County study, 7 years follow up.
Figures and Tables -
Analysis 1.19

Comparison 1 Screening with mammography versus no screening, Outcome 19 Mortality among breast cancer patients in the Two‐County study, 7 years follow up.

Comparison 1 Screening with mammography versus no screening, Outcome 20 Results for biased trial.
Figures and Tables -
Analysis 1.20

Comparison 1 Screening with mammography versus no screening, Outcome 20 Results for biased trial.

Comparison 1 Screening with mammography versus no screening, Outcome 21 Number of cancers.
Figures and Tables -
Analysis 1.21

Comparison 1 Screening with mammography versus no screening, Outcome 21 Number of cancers.

Table 1. Examples of varying numbers of women in the Swedish trials

Study

Age range

Study group

Control group

Reference

Malmö

40‐74

21242

21240

Andersson 1980

40‐74

21242

21244

Andersson 1983

40‐74

21088

21195

Andersson 1988

Kopparberg

total

47389

22658

Socialstyrelsen 1985

40‐74

39051

18846

Tabar 1985

40‐74

38589

18582

Tabar 1989

40‐74

38562

18478

Nyström 1993

40‐74

38589

18582

Tabar 1995

40‐74

38568

18479

Nyström 2000

40‐74

38588

18582

Nixon 2000

40‐74

data not available

data not available

Nyström 2002

40‐49

9625

5053

Tabar 1988

40‐49

data not available

data not available

Nyström 1993a

40‐49

9582

5031

Tabar 1995

40‐49

9650

5009

Nyström 1997

Östergötland

total

47001

45933

Socialstyrelsen 1985

40‐74

39034

37936

Tabar 1985

40‐74

38491

37403

Tabar 1989

40‐74

38405

37145

Nyström 1993

40‐74

38491

37403

Tabar 1995

40‐74

38942

37675

Nyström 2000

40‐74

39105

37858

Nixon 2000

40‐74

38942

37675

Nyström 2002

40‐49

10312

10625

Tabar 1988

40‐49

data not available

data not available

Nyström 1993a

40‐49

10262

10573

Tabar 1995

40‐49

10240

10411

Nyström 1997

Stockholm

40‐64

40318

19943

Frisell 1989a

40‐65 (sic)

38525

20651

Nyström 1993

40‐64

40318

19943

Frisell 1997

40‐69

39139

20978

Nyström 2000

40‐49

data not available

data not available

Nyström 1993a

40‐49

14842

7103

Frisell 1997

40‐49

14185

7985

Nyström 1997

40‐49

14303

8021

Nyström 2002

Göteborg

40‐59

20724

28809

Nyström 1993

39‐59

21650

29961

Bjurstam 1997a

40‐59

21000

29200

Nyström 2000

40‐49

10821

13101

Nyström 1993a

39‐49

11724

14217

Bjurstam 1997

40‐49

10888

13203

Nyström 2002

Figures and Tables -
Table 1. Examples of varying numbers of women in the Swedish trials
Comparison 1. Screening with mammography versus no screening

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Deaths ascribed to breast cancer, 7 years follow up Show forest plot

11

616327

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.72, 0.90]

1.1 Adequately randomised trials

4

292958

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.79, 1.09]

1.2 Suboptimally randomised trials

7

323369

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.61, 0.83]

2 Deaths ascribed to breast cancer, 13 years follow up Show forest plot

9

599090

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.74, 0.87]

2.1 Adequately randomised trials

4

292153

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.79, 1.02]

2.2 Suboptimally randomised trials

5

306937

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.67, 0.83]

3 Deaths ascribed to breast cancer, 7 years follow up, women below 50 years of age (Malmö 55) Show forest plot

9

356368

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.77, 1.04]

3.1 Adequately randomised trials

3

227333

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.78, 1.14]

3.2 Suboptimally randomised trials

6

129035

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.63, 1.05]

4 Deaths ascribed to breast cancer, 7 years follow up, women at least 50 years of age (Malmö 55) Show forest plot

7

261044

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.62, 0.85]

4.1 Adequately randomised trials

2

65625

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.64, 1.20]

4.2 Suboptimally randomised trials

5

195419

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.56, 0.81]

5 Deaths ascribed to breast cancer, 13 years follow up, women below 50 years of age Show forest plot

8

329511

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.73, 0.96]

5.1 Adequately randomised trials

3

218697

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.73, 1.03]

5.2 Suboptimally randomised trials

5

110814

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.64, 0.98]

6 Deaths ascribed to breast cancer, 13 years follow up, women at least 50 years of age Show forest plot

7

268874

Risk Ratio (M‐H, Fixed, 95% CI)

0.77 [0.69, 0.86]

6.1 Adequately randomised trials

2

74261

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.77, 1.15]

6.2 Suboptimally randomised trials

5

194613

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.62, 0.80]

7 Deaths ascribed to any cancer, all women Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 Adequately randomised trials

3

132118

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.95, 1.10]

7.2 Suboptimally randomised trials (unreliable estimates)

3

195871

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.93, 1.06]

8 Overall mortality, 7 years follow up Show forest plot

11

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 Adequately randomised trials

4

292958

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.94, 1.03]

8.2 Suboptimally randomised trials (unreliable estimates)

7

324977

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.96, 1.02]

9 Overall mortality, 13 years follow up Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 Adequately randomised trials

4

292958

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.95, 1.03]

9.2 Suboptimally randomised trials (unreliable estimates)

4

244868

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.97, 1.01]

10 Overall mortality, 7 years follow up, women below 50 years of age Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 Adequately randomised trials

2

211270

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.90, 1.04]

10.2 Suboptimally randomised trials (unreliable estimates)

5

99656

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.98, 1.16]

11 Overall mortality, 7 years follow up, women at least 50 years of age Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

11.1 Adequately randomised trials

1

39405

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.85, 1.20]

11.2 Suboptimally randomised trials (unreliable estimates)

4

161519

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.94, 1.00]

12 Overall mortality, 13 years follow up, women below 50 years of age Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

12.1 Adequately randomised trials

3

219324

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.92, 1.04]

12.2 Suboptimally randomised trials (unreliable estimates)

3

61344

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.92, 1.10]

13 Overall mortality, 13 years follow up, women at least 50 years of age Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

13.1 Adequately randomised trials

2

73634

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.95, 1.04]

13.2 Suboptimally randomised trials (unreliable estimates)

2

98261

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.97, 1.02]

14 Number of mastectomies and lumpectomies Show forest plot

5

250479

Risk Ratio (M‐H, Fixed, 95% CI)

1.35 [1.26, 1.44]

14.1 Adequately randomised trials

3

132321

Risk Ratio (M‐H, Fixed, 95% CI)

1.31 [1.22, 1.42]

14.2 Suboptimally randomised trials

2

118158

Risk Ratio (M‐H, Fixed, 95% CI)

1.42 [1.26, 1.61]

15 Number of mastectomies Show forest plot

5

250479

Risk Ratio (M‐H, Fixed, 95% CI)

1.20 [1.11, 1.30]

15.1 Adequately randomised trials

3

132321

Risk Ratio (M‐H, Fixed, 95% CI)

1.20 [1.08, 1.32]

15.2 Suboptimally randomised trials

2

118158

Risk Ratio (M‐H, Fixed, 95% CI)

1.21 [1.06, 1.38]

16 Number treated with radiotherapy Show forest plot

2

100383

Risk Ratio (M‐H, Fixed, 95% CI)

1.32 [1.16, 1.50]

16.1 Adequately randomised trials

1

42486

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [1.04, 1.49]

16.2 Suboptimally randomised trials

1

57897

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [1.17, 1.69]

17 Number treated with chemotherapy Show forest plot

2

100383

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.78, 1.19]

17.1 Adequately randomised trials

1

42486

Risk Ratio (M‐H, Fixed, 95% CI)

0.63 [0.39, 1.04]

17.2 Suboptimally randomised trials

1

57897

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.84, 1.34]

18 Number treated with hormone therapy Show forest plot

2

100383

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.55, 0.96]

18.1 Adequately randomised trials

1

42486

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.60, 1.08]

18.2 Suboptimally randomised trials

1

57897

Risk Ratio (M‐H, Fixed, 95% CI)

0.30 [0.12, 0.72]

19 Mortality among breast cancer patients in the Two‐County study, 7 years follow up Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

19.1 Mortality from cancers other than breast cancer

2

2063

Risk Ratio (M‐H, Fixed, 95% CI)

2.42 [1.00, 5.85]

19.2 Mortality from causes other than breast cancer

2

2063

Risk Ratio (M‐H, Fixed, 95% CI)

1.37 [0.93, 2.04]

20 Results for biased trial Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

20.1 Deaths ascribed to breast cancer, 7 years follow up

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

20.2 Deaths ascribed to breast cancer, 13 years follow up

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

20.3 Deaths ascribed to breast cancer, 7 years follow up, younger women (below 50 years of age)

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

20.4 Deaths ascribed to breast cancer, 7 years follow up, elderly women (at least 50 years of age)

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

20.5 Deaths ascribed to breast cancer, 13 years follow up, younger women (below 50 years of age)

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

20.6 Deaths ascribed to breast cancer, 13 years follow up, elderly women (at least 50 years of age)

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

20.7 Overall mortality, 7 years follow up

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

20.8 Number treated with radiotherapy

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

21 Number of cancers Show forest plot

7

512246

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [1.23, 1.35]

21.1 Adequately randomised trials (after 7‐9 years)

4

292979

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [1.18, 1.34]

21.2 Suboptimally randomised trials (before control group screen)

3

219267

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [1.24, 1.44]

Figures and Tables -
Comparison 1. Screening with mammography versus no screening